Early Total Care vs. Damage-Control Orthopedic Surgery: Evidence Based?

The management of musculoskeletal injuries in multiple-trauma has changed tremendously over the last decades. From the initial concept "patients are too ill to operate" to early total care (ETC) to damage-control Orthopedic surgery (DCO) and now individual concepts based on anatomical and physiological injury severity. Despite the undisputable benefit and decrease of mortality of these concepts in multiple-trauma management, fundamental evidence and large prospective randomized multicentre trials are still missing. In this article we present the advantages and disadvantages of ETC and DCO. The crucial step for successful management of multiple-trauma is the allocation of the right surgical principle (ETC/DCO) to the right patient. This most important task is presented and discussed in a separate chapter.